| NPI | 1275939332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA58902) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA MAPA5192) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA5192) | |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2021-03-26 |